Variability of morphology in photoplethysmographic waveform quantified with unsupervised wave-shape manifold learning for clinical assessment

<i>Objective.</i>We investigated fluctuations of the photoplethysmography (PPG) waveform in patients undergoing surgery. There is an association between the morphologic variation extracted from arterial blood pressure (ABP) signals and short-term surgical outcomes. The underlying physiology could be the numerous regulatory mechanisms on the cardiovascular system. We hypothesized that similar information might exist in PPG waveform. However, due to the principles of light absorption, the noninvasive PPG signals are more susceptible to artifacts and necessitate meticulous signal processing.<i>Approach.</i>Employing the unsupervised manifold learning algorithm, dynamic diffusion map, we quantified multivariate waveform morphological variations from the PPG continuous waveform signal. Additionally, we developed several data analysis techniques to mitigate PPG signal artifacts to enhance performance and subsequently validated them using real-life clinical database.<i>Main results.</i>Our findings show similar associations between PPG waveform during surgery and short-term surgical outcomes, consistent with the observations from ABP waveform analysis.<i>Significance.</i>The variation of morphology information in the PPG waveform signal in major surgery provides clinical meanings, which may offer new opportunity of PPG waveform in a wider range of biomedical applications, due to its non-invasive nature.